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Admission Systolic Blood Pressure and In-hospital Mortality in Acute Type A Aortic Dissection: A Retrospective Observational Study.

ABSTRACT: Background: Evidence between admission systolic blood pressure (SBP) and in-hospital deaths in acute type A aortic dissection (AAD) patients is inadequate. Here, we examined the relationship between SBP and in-hospital deaths in AAD patients. Methods: 703 AAD patients were enrolled from January 2014 to December 2018. The independent and dependent variables targeted were admission SBP and in-hospital deaths, respectively. Gender, age, body mass index (BMI), chronic renal insufficiency, smoking, hypertension, diabetes, laboratory indicators, and management were used as covariates. Results: The 703 participants had a mean age of 50.48 ± 11.35. About 76.24% of the participants were male. After adjusting for confounders, there was a negative correlation between AAD patients' admission SBP and in-hospital deaths (OR = 0.88, 95%CI 0.80-0.96). Consequently, a non-linear relationship of point 120 (mmHg) was detected between admission SBP and in-hospital deaths for AAD patients. Confidence intervals and effect sizes of the right (SBP >120 mmHg) and left (SBP ≤ 120 mmHg) sides of the inflection point were 0.96 (0.85-1.09) and 0.67 (0.51-0.88), respectively. The change in the male population and non-diabetes people was more pronounced according to subgroup analysis. Conclusions: Correlation between admission SBP and in-hospital mortality of AAD patients is non-linear. SBP negatively correlated with in-hospital mortality when ≤120 mmHg.

SUBMITTER: Yang G

PROVIDER: S-EPMC8329236 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundAlthough gender-related disparities in cardiovascular surgery have been investigated extensively in the past decades, knowledge about the impact of gender on outcomes after surgery for acute aortic dissection type A (AADA) is sparse. This study investigated the impact of gender on early morbidity and mortality and follow-up outcome in patients after surgery for AADA and to analyze gender-related risk factors for 30-day mortality.MethodsThis retrospective study included 368 consecutive patients (male 65.8% vs. female 34.2%) undergoing surgery for AADA between 2001 and 2016 at our department. Survival was estimated by Kaplan-Meier curves. Risk factors for 30-day mortality were assessed by multivariable logistic regression and interaction analysis.ResultsWomen were older (70.7?years vs. 60.6?years; p <? 0.001) and showed a higher logistic EuroSCORE I (31.0% vs. 19.7%, p?<? 0.001). In the male group, a higher portion of smokers (27.6% vs. 16.0%, p =?0.015) and intraoperatively, more complex procedures and longer cardiopulmonary bypass (CPB) (171?min vs. 149?min, p =?0.001) and cross-clamping times (94?min vs. 85?min, p =?0.018) occurred. 30-day mortality was 19.0% in the female and 16.5% in the male group (p =?0.545). Predictive for 30-day mortality in both genders was intraoperative blood transfusion, while in the female group chronic obstructive pulmonary disease (COPD), peripheral arterial disease and preoperative intubation were predictive. Preoperative cardiopulmonary resuscitation and duration of CPB time were predictors only in males. Averaged follow-up time was 5.2?years and survival did not differ between genders, even if it was stratified by age over 70?years.ConclusionsThis analysis demonstrated a similar and satisfactory survival in both genders after surgical treatment of AADA. Women and men differed significantly in age, unadjusted and adjusted risk factors and complexity of surgical treatment, but gender itself was no risk factor for mortality. These results suggest that the decision-making for surgical treatment should not depend on gender, but that accounting for sex-specific risk factors rather than common risk factors may help to improve the outcome in both genders.

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Admission Systolic Blood Pressure and In-hospital Mortality in Acute Type A Aortic Dissection: A Retrospective Observational Study.

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